From delivering some outstanding performances in La Liga Santander while on loan at Real Sociedad to dealing with the reality of the niggling injuries that blight the career of many a player, young Martin Ødegaard has come of age in the last six months.
Having been troubled with patellar tendinopathy for the latter part of Real Sociedad’s league programme, Martin was set to spend the close season working at his rehabilitation in Anoeta. But now that he’s been recalled from his loan period it’s back to Madrid and down to work in Valdebebas instead.
From a medical aspect, this won’t affect Martin’s schedule and his rehabilitation will continue as planned. He has also had the benefits of two sets of medical teams managing his injury.
Javier Barrera, Head of Sports Medicine at the Basque club, wasted no time in arranging for Martin to take another opinion from a specialist in Barcelona towards the end of the season. The outcome of that consultation was that no surgical intervention was indicated at the time and that Martin should focus instead on active rehabilitation.
Patellar tendinopathy can be defined as an overuse injury categorised by localised tendon pain with loading and dysfunction (Malliaras et al., 2013).
The term ‘tendinopathy’ is a common expression frequently used to describe injuries and conditions affecting the tendons of the body, particularly the patella tendon of the knee, the Achilles tendon, and the tendons of the rotator cuff muscles of the shoulder.
‘‘Tendinitis” is the traditional expression which implies that there is an inflammatory component present, while “tendinosis” normally refers to chronic conditions where the inflammatory stage has passed. Tendinopathy, therefore, is a generic expression used to describe most conditions affecting tendons in the body.
The issue with tendon injuries is that the healing process is often incomplete by the end of the inflammatory stage and the condition becomes chronic as a result. This can lead to structural changes occurring in the tendon which make the condition difficult to resolve.
These changes are addressed through a variety of treatment methods such as specific exercises, biomechanical analysis such as addressing players’ running style for example, and by other means such as shock-wave therapy.
There is evidence to support the use of shock-wave therapy as a treatment modality in the management of chronic long-term conditions such as tendinopathy (Everhart et al, 2017). Shock-wave therapy is a treatment which works on the premise that the inflammatory stage has long since passed.
The thinking behind this is that the most effective way to address a chronic condition is to essentially restart the healing process all over again by recreating an inflammatory response to encourage appropriate healing.
Stasinopoulos (2004), noted that patellar tendinopathy commonly occurs in athletes who participate in sports or activities that involve repetitive movements such as running, jumping, kicking and acceleration / deceleration.
Consensus on the most effective treatment, however, remains inconclusive (Lopez et al., 2018) and the condition is prone to recurrence.
At Real Sociedad, Martin would play in some games and miss others, depending on his symptoms. The difficulty with injuries or conditions of this nature is that they don’t necessarily force players to drop out of training or playing until they get to the stage where the pain reaches such a level that they have to stop.
Players will always play through pain and these ‘niggling injuries’ can go on for weeks, even months. Often, the hardest part of managing injuries of this type lies in convincing players that playing on with injuries like these increases the overall rehabilitation period by adding on time at the other end.
So on that basis, resting throughout the close-season and avoiding activity isn’t going to aid Martin Ødegaard’s recovery. Patellar tendinopathy responds to treatment and exercise as opposed to rest, and if there’s a biomechanical reason for Martin’s knee problem then that will have been addressed by now by the performance analysts.
It’s clear to Martin that he needs to put the work in during the close season if this condition is going to resolve and that will be his main objective. He needs to be active and working at the specific exercises and following the treatment protocols designed to address his injury, which hopefully will see him make a full recovery.
Martin is young, keen, and eager to impress Zinedine Zidane, he certainly isn’t going to want to sit out if he can avoid it.
His options might be limited though, and he may not have a choice other than to focus on getting fit in the meantime if the plan is to have him available in the longer-term.
Everhart JS, Cole D, Sojka JH, Higgins JD, Magnussen RA, Schmitt LC, Flanigan DC (2017). Treatment Options for Patellar Tendinopathy: A Systematic Review. Arthroscopy: The Journal of Arthroscopic and Related Surgery. Vol. 22 (4); 861 – 872
Lopes AD, Hespanhol Junior LC, Kamper SJ, Costa LOP. Exercise for patellar tendinopathy. Cochrane Database Syst Rev. 2018 Jul 18;2018(7): CD013078. doi: 10.1002/14651858.CD013078. PMCID: PMC6513560.
Malliaras P, Barton CJ, Reeves ND, Langberg H (2013). Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine. Vol. 43 (4); 267 ‐ 286
Stasinopoulos D, Stasinopoulos I (2004). Comparison of effects of exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy. Clinical Rehabilitation. Vol.18. (4); 347 - 352